1619(a)

1619(b)

A rule that lets people who stop getting Supplemental Security Income (SSI) benefits due to work income keep their Medi-Cal health coverage while earning up to $37,202 per year. 1619(b) also makes it easier to get SSI benefits started up again if your countable income goes below SSI's income limit. For 1619(b), you must continue to meet other SSI eligibility rules, such as the resource limit.

Note: If your earnings are over this limit and you have high medical expenses, you might still qualify for 1619(b). Ask your local Social Security office about the 1619(b) Individualized Earnings Threshold.

401(k) Retirement Account

A type of retirement plan in which people who are employed can automatically have money taken out of their paychecks and put aside into an account that is taxed less than a standard savings or investment account. This helps the account grow more quickly than other accounts. The person who puts the money aside can only use this money after reaching the age of 59 and a half. If money is withdrawn before that age, the person taking the money out has to pay a penalty.

A

ABLE Accounts

A type of financial account for people who have disabilities that began before they turned 26. ABLE (Achieving a Better Life Experience) accounts have tax advantages and the money in these accounts does not affect eligibility for many benefits, including Supplemental Security Income (SSI), Medi-Cal, and CalFresh (formerly Food Stamps). Money in ABLE accounts must be used for specific things, like education, housing, transportation, health care, work-related expenses, assistive technology, or other approved living expenses. Note: If you have more than $100,000 in your ABLE account, the money will be counted by the SSI program.

ABLE accounts can only be opened through specific programs or financial institutions and a person can only open one account. Each state regulates which financial institution offers ABLE accounts in that state. You do not have to open your account in your own state: if another state offers a program, it may let you open an account there. That lets you compare which financial institution offers the right options for you and means you can open an account even if no financial institution in your state offers accounts.

If you have an ABLE account and you work, you can put up to an extra $12,060 of your earnings into your account (on top of the regular $15,000 that is allowed). The $12,060 must be from your own earnings – it cannot be contributions from others or money you get from benefits or other unearned income.

Note: This means that if you earn $12,060 or more, you could have a total of up to $27,060 go into your ABLE account in a year. If you earn less than $12,060, the amount you could contribute would be lower.

If you work and save money in an ABLE account, you may qualify for the Saver’s Credit when you file your federal taxes.

Money can be rolled over tax-free from a regular 529 college savings plan to an ABLE account. That means that money which hasn’t been or won’t be used for college can instead be used for expenses that are approved for usage from an ABLE account.

If you have an account, you have to make sure that too much money isn’t contributed into your account (even if it is other people making the deposits). Check with your ABLE program if you have questions about this.

Active Work Requirement

ADAP (AIDS Drug Assistance Program)

A program that pays for some or all of the costs associated with HIV/AIDS medications. ADAP only covers Federal Drug Administration (FDA) approved medications on its formulary (list of covered prescriptions).

Adjusted Income

Administrative Law Judge

An official who oversees administrative hearings held to resolve a dispute between a government agency and a person affected by a decision of that agency. They oversee any initial appeal you may make with a government institution.

Affidavit of Support

A contract signed by the sponsor that shows that the immigrant applying for a green card is not likely to become dependent on the government for cash welfare or long-term care (nursing homes). There are two types of Affidavits of Support: Old (Traditional) and New (Enforceable).

Affordable Coverage (Employer-Sponsored Health Plans)

If you have an option that meets these standards, you and your family cannot qualify for government subsidies to get private insurance on Healthcare.gov. If your income is low enough, you may still qualify for Medi-Cal.

Americans with Disabilities Act (ADA)

A federal law that protects the rights of people with disabilities at work and in public places. The ADA makes it illegal for employers, the government, or other public agencies to discriminate against (to treat unfairly or unequally) disabled people at work and in most public places, places, such as restaurants, hotels, and theaters. The law also requires employers to make reasonable accommodations to allow employees with disabilities to do their jobs.

America's Job Centers of California (AJCCs)

Offices around the state that offer free tools, resources, and services that can help you find employment or training and get help with other work-related needs. AJCCs used to be called One-Stop Career Centers.

Appraisal

Apprenticeship

Asset Limit

The maximum amount of assets you're allowed to own while maintaining eligibility for a particular disability benefits program. Most benefits programs do not count everything you own, including the home you live in and one car you own. For Supplemental Security Income (SSI), the first $100,000 in an ABLE account is not counted as assets. For Medi-Cal, CalFresh (formerly Food Stamps), and some other programs, none of the money in an ABLE account is counted.

Also called a "resource limit."

Assets

Things that you own, like a car or a house. You can only own a certain amount in assets and still qualify for many health care and disability benefit programs. The home you live in and the car you drive to work are exempt under most Social Security and state disability benefit programs. For Supplemental Security Income (SSI), the first $100,000 in an ABLE account is not counted as assets. For Medi-Cal, CalFresh (formerly Food Stamps), and some other programs, none of the money in an ABLE account is counted.

Also called "resources."

Assets for Independence Act (AFIA)

Legislation that established Individual Development Account (IDA) programs for applicants who are not on CalWORKs. The three goals of AFIA include: providing individuals and families with incentives to save earned income, increasing self-sufficiency, and improving the community.

Assistive Technology

Assistive Technology Device (Federal Definition)

According to the Technology Related Assistance to Individuals with Disabilities Act of 1988 (Tech Act):

Any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

According to the same law, an assistive technology service is:

Any service that directly assists an individual with a disability in selection, acquisition or use of an assistive technology device.

Bankruptcy

Base Period

The yearlong period that SDI uses to determine your regular wages. It starts around 17 months before your disability and ends around 5 months before then. Your base period is divided into 4 quarters, and the quarter with the highest wage is used to determine your benefit amount.

Benefit Period

The time period that Medicare uses to measure an individual’s use of hospital and skilled nursing facility care. A benefit period begins the day an individual enters a hospital or skilled nursing facility (SNF). The benefit period ends after the individual is released and hasn't received any further hospital care (or skilled care in a SNF) for 60 consecutive days. If an individual goes into the hospital after one benefit period has ended, a new benefit period begins. The inpatient hospital deductible may be charged for each benefit period. There is no limit to the number of benefit periods an individual may have.

If you need assistance with your Medicare, the Health Insurance Counseling & Advocacy Program can help. HICAP provides free information and counseling to people with Medicare. You can call HICAP at 1-800-434-0222 or visit the HICAP website.

If you need assistance with Medi-Cal and have a disability, you can contact Disability Rights California at 1-800-776-5746 or visit their website. You may also be able to get help with Medi-Cal from a local legal aid organization. The Health Consumer Alliance website has a lot of useful information about Medi-Cal, including a web page that can direct you to a local legal organization for assistance.

If you have questions or need assistance with a program or benefit not listed here, contact an Independent Living Center (ILC). Independent Living Centers provide peer support and information on a wide range of topics for people with disabilities.

Benefits Planning Query (BPQY)

A report that summarizes your current Social Security disability benefits and available work incentives. To order one, visit your local Social Security office or call 1-800-772-1213 (voice); 1-800-325-0778 (TTY). Be sure to review your BPQY carefully. If you have questions about it, contact a Benefits Planner or Social Security.

Tip: The BPQY is form number SSA-2459. If a Social Security Claims Representative does not know what a BPQY is, mention the form number.

Blind Work Expenses (BWE)

Documented expenses for services or items that you need in order to work. Service animal expenses, transportation to and from work, and visual and sensory aids are examples of BWEs. You must be eligible for Supplemental Security Income (SSI) based on blindness to use BWEs.

Blue Book (Listing of Impairments)

The Social Security publication that provides detailed information about disability programs to physicians and other health care professionals. The Blue Book includes the complete Listing of Impairments, which lists and defines those conditions considered severe enough to prevent a person from doing any gainful activity. The Blue Book can now be accessed online.

Breast and Cervical Cancer Treatment Program

Budget Month (Benefits Eligibility)

The month a benefits program looks at when it decides if you qualify and what you get in benefits. Programs look at your income and resources from the budget month.

The budget month may be the same as the current month, one month before the current month, or two months before the current month. Which month a program looks at depends on the program rules and your situation.

Note: DB101 Calculators use the correct budget month for each month and program.

If you have been getting SSI benefits for more than two months, the amount you get is usually based on your income from two months ago.

If you don't get SSI benefits, but your countable income drops below SSI's income limit, you might not have to wait two months to start qualifying for SSI. Instead, your first month of SSI benefits may be based on your income from the current month.

Usually, the second month of SSI benefits are based on income from one month ago.

If you have been getting SSI benefits for a while, but then your income goes over SSI's income limit, you don't still qualify for SSI benefits. Your benefits eligibility is based on your income from the current month.

C

Cal MediConnect

Combined managed care plans for some people with both Medicare and Medi-Cal. People who have Cal MediConnect plans have just one card for their Medicare and Medi-Cal and any billing automatically takes into account the benefits both programs provide.

Cal MediConnect plans exist in seven California counties: Alameda, Los Angeles, Riverside, San Bernadino, San Diego, San Mateo, and Santa Clara. County social service agencies will send letters to people on Medicare and Medi-Cal to notify them when they have the option to choose a Cal MediConnect plan.

CalFresh

Formerly called Food Stamps, CalFresh is a county-run, federal program that helps people with low incomes buy food. Nationally the program is called the Supplemental Nutrition Assistance Program (SNAP). In California, the benefits are issued monthly on an electronic debit card (EBT) that can be used to buy most foods at many markets and food stores. To apply for CalFresh, go to the Department of Social Services website.

CalWORKs

California Work Opportunity and Responsibility to Kids. The state welfare-to-work program that provides income support and access to health coverage on a temporary basis. CalWORKs was formerly Aid to Families with Dependent Children (AFDC).

CalWORKs Maximum Grant Levels

This table shows CalWORKs maximum possible monthly cash benefit amounts. The maximum benefit for a family depends on how many people are in the family, whether the family is exempt because all caretakers are disabled, and whether it lives in Region 1 or Region 2.

Region I includes the more urban counties (Alameda, Contra Costa, Los Angeles, Marin, Monterey, Napa, Orange, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Sonoma, and Ventura) where cost of living is higher, so the maximum benefit is correspondingly higher. Region II includes the more rural counties (all of the ones not listed above).

A program that pays for private health insurance premiums for individuals who are disabled due to HIV or AIDS and who do not qualify for Medi-Cal/HIPP. Enrollment is administered through AIDS organizations authorized by CARE/HIPP.

Catastrophic Plan

A health coverage plan that generally has a lower premium and provides most benefits only after a large deductible has been paid. This sort of plan is most useful for people who do not have regular medical expenses, but wish to be covered in case of an accident or other sudden and significant medical needs. These plans may allow you to see your primary care provider up to 3 times per year and get preventive care without paying the deductible.

If you are under 30, you can sign up for a catastrophic plan on Covered California. If you are over 30, a catastrophic plan will not exempt you from having to pay the $695 tax penalty that people without health insurance have to pay in 2018 because of the individual mandate.

Citizenship Status

Assuming they meet all other eligibility criteria, U.S. citizens and Qualified Aliens (inlcuding those who meet I-551 or I-94 status) are eligible for both Social Security and state public benefits programs.

Legal residents who don't have I-551 or I-94 status may be eligible for some state programs, but not for Social Security programs. This could include Legal Permanent Residents (LPRs), refugees, asylees, conditional entrants, people certified as victims of trafficking, certain people whose immigration status is pending, people under Temporary Protected or Family Unity Beneficiary Status, Lawful Temporary Residents, applicants for asylum, people who have been granted or are applying for withholding of removal, and all other people with a lawfully residing immigrant status.

People who are undocumented or non-immigrants are not eligible for any of these programs.

Closing Costs

Costs associated with the completion of a sale of real estate. Closing costs are not usually included in the sale price of the property. Some examples of closing costs are applicable taxes, fees for appraisals and recording the deed (the deed is an official document that shows details of a legal agreement, especially about who owns a building or a piece of land).

Co-Insurance

The portion of the payment for medical services that an individual is responsible for. For example, your health coverage may pay for 80% of the costs of a service, while you will have to pay the remaining 20%. That 20% is known as "co-insurance."

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Continuation Coverage

If you lose access to group health insurance that you got through your employer for certain reasons, including a job change, divorce, or job loss, there are laws that allow you to continue your group coverage temporarily. This is known as continuation coverage. You will usually have to pay the full costs of your continuation coverage, including any portion of the premium your employer may have paid for in the past. The federal continuation coverage law is called COBRA. Many states also have their own continuation coverage laws.

Continuing Disability Review (CDR)

A periodic review to determine if there has been any medical improvement in your condition and/or to determine whether you continue to be eligible for Social Security benefits for other reasons. The two types of reviews are called a medical CDR and a work CDR.

Conversion Policy

A conversion insurance policy is something you can buy when your employer-sponsored group health insurance policy ends. It lets you keep buying insurance through the same insurance company. You may have to use up all your COBRA coverage first, before you can get a conversion policy, depending on the regulations in your state.

Cooking Facilities

Having cooking facilities means that you have a refrigerator and at least 2 burners. Hotplates count as burners if they have temperature controls. You can substitute a microwave oven for one of the burners or hotplates.

Copayment

A set amount you have to pay when you receive medical services. For example, you may have to pay $30 every time you visit the doctor or $20 to get a prescription refilled. This is also known as a "copay."

Countable Earned Income

Countable earned income is the portion of your earned income that is counted by a benefits program. Earned income includes salaries, wages, tips, and any other money that you receive as pay for work that you do.

For example, the SSI program uses a special calculation to determine your countable earned income, your total countable income, and ultimately, your SSI benefit.

Countable Income Calculation (Medi-Cal)

The formula used to determine income and to consider eligibility for SSI-Linked, Medically Needy, and Aged and Disabled Medi-Cal programs.

Step 1: If you have unearned income (for example, an SSDI benefit), subtract a $20 "General Income Exclusion" from it to calculate your countable unearned income. If you do not have unearned income, this exclusion is applied to any earned income.

Step 2: If you have earned income (for example, wages), subtract a $65 "Earned Income Exclusion" from it (along with the remainder of the $20 "General Income Exclusion" that you have not applied to Unearned Income), along with any Impairment Related Work Expenses, and divide the resulting figure by two to find your countable earned income. If you have Blind Work Expenses, subtract them after you divide by two.

Countable Income Calculation (SSI)

The calculation used to determine how much of your unearned and earned income is counted when determining your SSI benefit and eligibility.

Step 1: If you have unearned income (for example, an SSDI benefit), subtract a $20 "General Income Exclusion" from it to calculate your countable unearned income. If you do not have unearned income, this exclusion is applied to any earned income.

Step 2: If you have earned income (for example, wages), subtract a $65 "Earned Income Exclusion" from it (along with the remainder of the $20 "General Income Exclusion" that you have not applied to Unearned Income), along with any Impairment Related Work Expenses, and divide the resulting figure by two to find your countable earned income. If you have Blind Work Expenses, subtract them after you divide.

Countable Resources (SSI)

Resources are things you own, like a home or car. To be eligible for SSI, you can only have up to $2,000 in resources ($3,000 for a couple).

When determining whether or not you qualify for SSI, Social Security excludes certain resources from your countable resource total. Your home and one car do not count as resources, for example. Income received from Earned Income Tax Credits (EITC), Child Tax Credits (CTC), CalFresh (formerly Food Stamps), grants, scholarships, fellowships, gifts, property essential to self-support, Individual Development Accounts (IDAs), and many other items may be excluded as well. Additionally, for SSI, the first $100,000 in an ABLE account are not countable resources.

Countable Unearned Income

Countable unearned income is the portion of your unearned income that is counted by a benefits program. Funds received from sources for which no paid work activity is performed are considered "unearned income" (for example, disability benefits such as SSDI, SSI, short- and long-term disability insurance; VA benefits; Workers' Compensation; income from a trust or investment; spousal support).

For example, the SSI program uses a special calculation to determine your countable earned and unearned income, your total countable income, and ultimately, your SSI benefit.

County Organized Health System (COHS)

Health-insuring organizations that are organized and operated by a governing board appointed by the county’s Board of Supervisors. All Medi-Cal beneficiaries residing within the county are required to enroll unless they have a voluntary aid code, which allows them to enroll in fee-for-service Medi-Cal. The first plan was implemented in Santa Barbara County in 1983. Five County Organized Health Systems plans operate in eight counties: Monterey, Napa, Orange, San Mateo, Santa Barbara, Santa Cruz, Solano, and Yolo.

Coverage Effective Date

Coverage Levels (Health Insurance)

Labels for private health coverage options that give people an idea how much they would have in out-of-pocket expenses, such as copayments, coinsurance, and deductibles, when they use covered services. Plans that are the same coverage level should have roughly the same out-of-pocket expenses.

There are four different levels of plans available to most people:

Platinum plans have the highest monthly premiums and the lowest out-of-pocket expenses when you get medical care.

Gold plans have slightly lower premiums and slightly higher out-of-pocket expenses when you get medical care.

Silver plans have lower premiums. The out-of-pocket expenses for medical services depend on your family’s income; if it is at or below 250% of the Federal Poverty Guidelines (FPG), the out-of-pocket expenses may be as low as a gold or platinum plan.

Bronze plans have the lowest monthly premiums and the highest out-of-pocket expenses when you get medical care.

You may see plans with percentages ranging from as low as 60% for Bronze plans to as high as 90% for Platinum plans. A lower percentage means the plan has higher out-of-pocket expenses when you get medical care, while a higher percentage means the plan has lower out-of-pocket expenses. Plans with lower percentage ratings usually have lower monthly premiums. Note: These percentages do not tell you exactly what percentage of your family's expenses your plan will pay for. They are based on averages for thousands of families and how much your plan actually ends up paying for your family could be much higher, or much lower, than what the percentage rating says, depending on the services your family needs.

Credit Limit

Credit Report

A summary of your financial history that is prepared by a credit bureau. It includes information on where you live, how you pay your bills, and whether you’ve been sued or arrested, or have filed for bankruptcy.

Credit Score

A number (between 300 and 850) that is based on a person’s credit history, that is used by lenders to measure whether or not a person would be likely to repay debts. People who pay all of their debts on time will have a higher score; people who do not pay their debts on time will have a lower score. It is easier to get loans if you have a high credit score.

Department of Veterans Affairs (VA)

The U.S. Department of Veterans Affairs (VA) is a government-run benefits system for military veterans and their families. The VA has hundreds of medical facilities, clinics, and benefits offices. The benefits the VA provides include Disability Compensation, VA Pension, education, home loans, life insurance, vocational rehabilitation, survivors benefits, medical benefits, and burial benefits.

Disability (Definition used by California State Disability Insurance - SDI)

Any illness or injury which prevents an individual from doing their regular or customary work. SDI includes disabilities resulting from elective surgery, pregnancy, childbirth, or a related medical condition. The disability must be verifiable by a medical provider. The SDI program may require some applicants to undergo an Independent Medical Examination to determine disability status.

Disability (Definition used by CalWORKs)

A condition that is expected to last at least 30 days and that significantly impairs the individual’s ability to be regularly employed or participate in Welfare-to-Work activities.

To qualify for an exemption from Welfare-to-Work activities due to a disability, a CalWORKs recipient must provide verification from a physician that states the disability, its expected duration, and the extent to which it impairs employment and/or Welfare-to-Work activities. The individual must also actively seek medical treatment to qualify for an exemption.

Disability (Definition used by private insurers)

A level of impairment that causes private insurers to provide benefits to people who have paid a monthly premium for coverage.

There are two common levels of disability according to private insurers:

Own-Occupation Disability (or “Own Occ” ) means your disability prevents you from performing your own occupation, which means you cannot do the work or job you have been trained to do and have experience in

Sometimes Any Occ means that your disability prevents you from performing any occupation that pays at least a specified percentage of what you earned before your disability

Own-occupation insurance policies pay you if you are unable to perform your own occupation, even if you are able to get a different type of job. They have higher premiums than policies that require you to be unable to perform any occupation. Check with your insurer to see which definition of disability your plan has.

Disability (Definition used by Social Security for Adults)

The inability to engage in any Substantial Gainful Activity (SGA) due to any medically determinable physical or mental impairment which can be expected to result in death or last for a continuous period of at least 12 months.

A person must not only be unable to do his/her previous work but cannot, considering age, education, and work experience, engage in any other kind of SGA which exists in the national economy. It doesn't matter whether such work exists in the immediate area, or whether a specific job vacancy exists, or whether the worker would be hired if he/she applied for work. The worker’s impairment(s) must be the primary reason for his/her inability to engage in SGA.

Disability (Definition used by Social Security for Children)

For a child under age 18, a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.

Disability (Definition used by the ADA)

Under the Americans with Disabilities Act (ADA), you are disabled if you have, have a record of, or are regarded as having a physical or mental impairment that substantially limits one or more major life activities, such as hearing, seeing, speaking, walking, breathing, performing manual tasks, caring for oneself, learning, or working. Major life activities also include the operation of major body functions, including:

Disclosing a Disabling Condition

The process of telling your employer – or potential employer – that you have a disability. Your employer does not have the right to ask you about your disability during the hiring process before a job offer is made. Even after a job offer, there are legal limits about when and what an employer can ask about disability.

Generally, the only time it is required to disclose a disabling condition at the workplace is when requesting a reasonable accommodation. Even then, the requirement is only to present the employer with information demonstrating that a reasonable accommodation is needed for the person to perform the essential functions of the job.

Domestic Partner

Neither person is married to someone else, or is a member of another domestic partnership with someone else that has not legally ended

You are not related by blood in a way that would make it illegal for you to be married to each other in your state

You are both at least 18 years of age

You are both members of the same sex, or one or both of you are over the age of 62 and meet the eligibility criteria under Title II of the Social Security Act for old-age insurance benefits, or Title XVI of the Social Security Act for aged individuals

You are both capable of consenting to the domestic partnership, and

You agree to go through the California courts to end the domstic partnership or legally separate, or any other legal decisions related to your partnership.

Domestic Violence Survivors

Donut Hole

The gap in Medicare Part D coverage when you have between $3,750 and $7,508.75 in total drug costs in a year.

People on Medicare who fall within the “donut hole” get a 65% discount on brand name prescription drugs and a 56% discount on generics. This discount will continue to grow until 2020, when the donut hole coverage gap is closed completely. These changes are happening as a result of the Affordable Care Act passed in 2010.

Down Payment

Down-Payment Assistance Program

Help offered by some cities and counties that may reduce a homebuyer’s portion of the down payment to as little as 1% of the purchase price. The rules are different for every program, but usually the homebuyer does not need to repay this financial help until the homebuyer sells the home or finishes paying off the original mortgage. In some cases, the homebuyer may not have to repay it at all.

Dual-Eligibles

Earned Income (EI)

Salaries, wages, tips, professional fees, and other amounts you receive as pay for physical or mental work you perform. This can include things you get in exchange for work instead of wages, such as food, shelter, or other items. Funds received from any other source are not included. (Contrast: unearned income.)

Earned Income Deduction (Medi-Cal)

Income received from work that is disregarded in the countable income calculation. This calculation evaluates an individual’s financial eligibility for Aged and Disabled Federal Poverty Level (ADFPL), Breast and Cervical Cancer Treatment Program (BCCTP), In-Home Supportive Services (IHSS), Medically Needy (MN) and Working Disabled Program (WDP) Medi-Cal.

Earned Income Disregard (EID)

A rule that helps people with disabilities getting housing benefits — like Section 8, public housing, and Housing Opportunities for Persons with AIDS (HOPWA) — try working.

If you have a disability and get a housing benefit that has an EID rule, you can start working and your new earnings will not be counted by the program during the first year after you start working. That means your rent won’t go up and you won’t lose the benefit because of your work. During the second year after you start working, only 50% of your earnings will be counted.

Earned Income Tax Credit (EITC)

A federal income tax credit for low income working individuals and families. The credit reduces the amount of federal income tax you owe and can result in a refund check. Most people claim their Earned Income Tax Credit (EITC) when they file their federal income taxes.

Elective Coverage

Optional State Disability Insurance (SDI) for the self-employed. Individuals must pay premiums based on self-employment taxes. Unlike SDI for employees, elective coverage generally provides income replacement benefits for a maximum of 39 weeks.

Eligible Couple (SSI)

A married couple where the partners live together and both qualify for Supplemental Security Income (SSI). The maximum SSI benefits amount for an eligible couple is $1,532.14, which is only about 150% of the individual maximum of $910.72.

Note: If you live in the same household as somebody else and the two of you act as though you are married and present yourselves to the community as being married, Social Security will consider you a married couple for SSI purposes. This is often referred to as "holding out."

Note: For SSI, Social Security only recognizes same-sex couples as married if they are legally married under California law. (The rules are different for SSDI.)

Employment Network

An employment services agency that is approved by Social Security. Employment Networks may offer a variety of services such as job readiness services, placement services, vocational rehabilitation, training, job coaches, transportation or other supports.

Employment Network examples:

Employers

Employers offering or arranging for job training

Employers collaborating with community based organizations

Transportation providers

Staffing and placement agencies

Consumer groups

State Department of Rehabilitation

Private providers of rehabilitation services

Vocational rehabilitation Service Projects for American Indians with disabilities

Cottage industries such as benefits planning services combined with other services

Public or private schools providing transitional education or career development services

Organizations working with ethnic, disability, or religious faith groups

Entrepreneur

Essential Functions

The fundamental job duties that you must be able to perform on your own or with the help of a reasonable accommodation. An employer cannot refuse to hire you because your disability prevents you from performing duties that are not essential to the job. At the same time, you cannot ask for an essential function to be removed from your job description as a reasonable accommodation.

Expected Family Contribution (EFC)

Expedited Reinstatement of Benefits

A quicker way to get benefits restarted for individuals whose Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI) ends due to employment. You get up to six months of benefits while SSA decides if you have medically improved or not. This provision is available for up to five years after your benefits end.

Extended Period of Eligibility (EPE)

A three-year period (36 months) after your SSDI Trial Work Period ends, during which you can keep getting SSDI benefits in any month when you earn less than the Substantial Gainful Activity level ($1,180 in 2018; $1,970 if you're blind).

If you earn more than SGA, your SSDI benefits will be suspended. However, during the EPE, you are eligible to have your SSDI benefits restarted if your earnings drop below SGA.

F

Fail First Rules

Fair Share (SSI)

The amount that each individual in a household is responsible for spending each month on food and shelter. If you live alone, it is the full cost of food and shelter. If you live with others, it is an equal portion of the total food and shelter expenses. For example, if you and three other people live together and spend a total of $4,000 per month on rent, utilities, and food, a fair share for each of you would be $1,000.

For the Supplemental Security Income (SSI) program and some other programs, whether an adult pays the fair share of expenses may affect benefits eligibility or benefits amounts.

Family and Medical Leave Act (FMLA)

A federal law that allows you to take up to 12 weeks off of work for the birth or adoption of a child, to care for a family member, or if you have a serious medical condition. You need to have worked for your employer for at least one year to qualify for FMLA coverage and your employer must employ at least 50 people.

Family Size

For the purposes of comparing your household income to the Federal Poverty Guidelines (FPG), count the number of people you have living together as a family. Include yourself, your spouse, and any children, parents or other relatives who are listed on the same tax return. If there is a pregnant woman in your household, count the unborn baby as well.

Federal Benefit Rate (FBR)

The national benefit amount, established by the Social Security Administration (SSA), for Supplemental Security Income (SSI) recipients. For 2018, the FBR is $750 for an individual and $1,125 for a couple. Some states supplement this amount with additional payments for SSI beneficiaries.

Federal Housing Administration (FHA) Loan

Loans offered by banks and mortgage lenders that are insured by the federal government. They allow buyers to make much smaller down payments and are typically available for people with lower credit scores.

Federal Poverty Guidelines (FPG)

Monthly and annual income amounts used to determine financial eligibility for state and federal benefit programs.

Each year, the U.S. Department of Health and Human Services (HHS) issues the Federal Poverty Guidelines (FPG) in the Federal Register. The current FPG for one person is $12,140 per year; for two people, it's $16,460. Add $4,320 for each additional person.

Note: Different state and federal programs adopt the new Federal Poverty Guidelines on different dates each year.

Fixed-Rate Mortgage

Foreclosure

A situation in which a mortgage lender (or financial institution) takes possession of the property because the borrower has not made payments on interest or principal for a certain period of time. Once the lender takes over the property, it usually sells at a discounted price so as to recover the amount lost on the mortgage loan.

Fully-Insured Plan

An insurance plan purchased for employees by an employer, through an insurance company. The employer pays premiums to that company, and the insurance company is responsible for providing the costs of health care, as agreed upon in the policy. Fully-insured plans are subject to federal and state regulation.

G

General Enrollment Period

The period of time between January 1 and March 31 when a Medicare beneficiary can sign up for Part B coverage. Benefits will not begin until July 1 of that year, and a beneficiary may be subject to a late enrollment fee of 10% for each 12 month period they did not have Part B Medicare.

Gross Income

Gross Misconduct

A serious violation of company policy or the commission of a crime affecting the workplace that may result in the loss of COBRA benefits. Although "gross misconduct" is not defined in COBRA legislation, past examples include embezzlement, misrepresentation, theft, and non-work related violence.

Health Insurance Portability and Accountability Act (HIPAA)

A law that protects the privacy and confidentiality of your health information, such as medical records and test results. It regulates how health care providers are allowed to handle and share your protected health information.

HIPAA also prevents group health plans from denying you coverage based on your health condition and provides protections for those buying individual health coverage. However, these parts of HIPAA are protections that are no longer needed, since the Affordable Care Act provides all the same protections, plus more.

Health Screening

If a person enrolls in a Medicare supplement during the Medigap open enrollment period, an insurance company cannot use health screening. But, if a person tries to enroll in a Medicare supplement outside of the open enrollment period, then a private insurance company can still use health screening.

High-cost Medical Condition

Medi-Cal has a list of certain conditions, like AIDS, that they automatically consider high cost. For other conditions, Medi-Cal estimates how much it would cost them to pay for your condition. They then estimate how much it would cost them to pay for your private insurance premiums. Conditions that are more expensive for Medi-Cal to cover are high cost conditions.

High-Deductible Plan

A health coverage plan with a relatively low premium that usually doesn’t pay for the first few thousand dollars of health care expenses (this is your deductible) but will typically cover your expenses after you pay a certain set amount.

HIV/AIDS Disability Form 4814 for Social Security

A form for individuals with HIV/AIDS who are applying for Social Security Disability Insurance (SSDI) benefits. The form requires physicians to identify whether an individual has one of the 41 opportunistic infections listed on the form, and to specify any "repeated manifestations" of other symptoms that restrict certain aspects of the individual's life.

Hospice Care (Medicare)

Services covered by Medicare Part A for individuals with a terminal illness. Services may include prescriptions for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare. Hospice care is usually given in an individual’s home; however, Medicare may cover some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest).

Household

A group of people who live together as a family. Eligibility rules for benefits programs often vary depending on how many people live in your household.

The exact rules for who counts as a member of a household depend on the program. For most programs, your household includes the following people if they are living with you:

Yourself

Your spouse

Your children

Your spouse's children

If you are under 18, for most programs your household also includes the following people if they are living with you:

Your parents

Your stepparent if your other parent lives with you

Your siblings and stepsiblings

Many programs also consider these people part of your household if you over 18. And for some programs, other people living with you, such as grandparents, cousins, or others, may also be considered part of the household.

Housing Opportunities for Persons with AIDS (HOPWA)

A program run through local housing authorities that can give rental help to people living with HIV/AIDS and their families. HOPWA funds can also give short-term rent, mortgage, and utility payment help.

Hunt v. Kizer

Impairment Related Work Expenses (IRWE)

Documented expenses for services or items that are related to a serious medical condition or impairment and needed in order to work. Wheelchairs, physician visits, copayments for prescriptions, and other medical expenses are some examples of IRWEs. The expenses must be verified by original receipts and canceled checks and approved by Social Security.

Independent living

Independent Living Centers

Offices that help people with disabilities live independently by offering information, teaching skills, and helping plan benefits. Your local Independent Living Center (ILC) has information about all aspects of living with a disability, including housing, transportation, Personal Assistance Services (PAS), employment, education, and benefits.Independent Living Centers are run by people with disabilities.

Independent Review Entity

Indigent Exception

A deeming exception for CAPI applicants whose sponsor signed an Old Affidavit of Support. An individual is considered to be indigent if he/she receives less than the federal Supplemental Security Income (SSI) benefit amount - $750 per month in 2018 for an individual ($1,125 for a couple).

Individual Development Account (IDA)

A savings account in which your deposits are "matched" at a certain rate. If you have a 2-to-1 match, for example, an additional $2 will be deposited for every $1 that you deposit in your account. IDAs are usually used to save for school, purchasing a home, or starting a business.

Individual Disability Policy

Wage-replacement coverage you buy directly from an insurance company, usually through an agent, that provides benefits if you become disabled. You are responsible for paying for the entire premium, and most individual policies require medical underwriting.

Individual Health Coverage

Private health insurance an individual or family purchases. The individual or family pays a monthly premium and the plan agrees to pay a portion of the cost of approved medical services when needed, like for preventive care, lab tests, surgery, or prescription drugs. The easiest way to purchase an individual plan is through Covered California.

The government may help individuals and families with low to middle income who get their coverage through Covered California pay for their monthly premiums and a portion of the cost of approved medical services.

Individual Mandate

A part of the Affordable Care Act (ACA) that requires most Americans to have health insurance that meets a minimum standard, or pay a fine. This fine is sometimes called the ACA “tax penalty.” Public insurance programs like Medicare or Medi-Cal, insurance offered through your employer, and insurance you buy through Covered California all count as meeting the individual mandate.

You do not have to pay a fine, even if you do not have health insurance, if:

You cannot afford the lowest cost plan option (because either the lowest cost plan is more than 8% of your income or your income is low enough that you don’t legally have to file taxes)

You have a religious objection

You are an American Indian

You are only without coverage for less than three months

You are an undocumented immigrant, or

You are incarcerated.

If you do not have health coverage, and you do not meet any of the exceptions, you will have to pay a fine each year you do not have coverage.

The tax penalty (individual mandate) continues to be law for 2017 and 2018

The Tax Cuts and Jobs Act, signed at the end of 2017, is set to end the tax penalty (individual mandate) for health coverage starting in 2019. It does not affect this rule for health coverage in 2017 and 2018.

The bottom line:

For 2017, if you didn't have coverage, you may still have to pay a penalty on your 2017 taxes (due in April of 2018).

For 2018, if you don't have coverage, you may still have to pay a penalty on your 2018 taxes (due in April of 2019).

Individual Plan for Employment (IPE)

Individual Retirement Account (IRA)

A type of retirement plan in which people who are employed can put aside money every year into an account that is taxed less than a standard savings or investment account. This helps the account grow more quickly than other accounts. The person who puts the money aside can only use this money after reaching the age of 59 and a half. If money is withdrawn before that age, the person taking the money out has to pay a penalty.

Individual Threshold Amount

A personal income limit that enables an individual to retain Supplemental Security Income-linked Medi-Cal coverage when their earnings go above the state's threshold amount. Social Security will determine an Individual Threshold Amount if the individual has Impairment Related or Blind Work Expenses, a Plan to Achieve Self-Support, a publicly funded personal attendant, or medical expenses above the state average amount.

Individual Work Plan (IWP)

A formal agreement between an individual in the Ticket to Work program and an Employment Network that describes how services will help the person to achieve an employment goal. The IWP includes specific steps and a time schedule that may span several years.

Individualized Education Program (IEP)

An educational plan for a student receiving special education services. The IEP is created with input from parents, teachers, staff, and the student. It includes information on the student’s current performance, goals and evaluation, and on what specific services the student will need.

Informed Choice

Making decisions based on complete and accurate information about your specific situation. Informed choice happens through talking with people that support you and doing things that help you make decisions about your life. It means that your concerns about myths and barriers about working and benefits are addressed. It also means that you understand all your options, how to get past barriers, and understand risks and benefits of your decisions. Part of this is seeing that your options are not limited to just disability programs. Professionals that help you in your decisions are being asked to use person centered ways to support informed choice in your life.

In-Home Supportive Services (IHSS)

A program that provides domestic, paramedical, and personal assistance services for people with disabilities so that they can live independently or maintain employment safely. The IHSS program provides an alternative to living in an institution for many people.

Initial Enrollment Period (Medicare)

The period when a beneficiary can first sign up for Medicare Part B or Part D. For Social Security Disability Insurance (SSDI) and Childhood Disability Benefits (CDB) beneficiaries, the initial enrollment period begins during the 24th month of a beneficiary’s SSDI or CDB payments. The initial enrollment period typically lasts about 10 months.

Initial Enrollment Period (Private Coverage)

In-Kind Support and Maintenance (ISM)

A Supplemental Security Income (SSI) term that describes food and/or shelter which is supplied or paid for by someone other than the SSI beneficiary. Shelter expenses can include rent, mortgage payments, property taxes, heating fuel, gas, electricity, water, sewer service, and garbage collection.

Internship

Interval Steps

Measurable milestones that show progress towards achieving a vocational goal in a Plan to Achieve Self-Support. For example, if the goal is to obtain a job, the job search would be considered an interval step.

Lawful Permanent Residents (LPRs)

Lifetime Reserve Days

The days following a 90-day hospitalization. Medicare allows an individual 60 lifetime reserve days per benefit period that may only be used once during an individual’s lifetime. Medicare will pay for lifetime reserve days, whether used at once or over the individual's lifetime. However, the individual must pay for the daily coinsurance of $670 in 2018.

Loan

Loan Underwriting

The process of reviewing all information collected in loan paperwork to figure out whether or not the loan is a good risk. The loan is evaluated based on the lender’s guidelines and practical experience.

Long-Term Care

Services that assist individuals with long-term medical and personal needs. Long-term care may include medical services, physical therapy, custodial care, and assistance with activities of daily living such as dressing, eating, and bathing. Long-term care may be provided at home, in the community, or in facilities, including nursing homes and assisted living facilities. Medicare will not pay exclusively for custodial care.

Long-Term Disability Insurance

Private insurance that replaces some of your income when you can't work because of a disability. Long-Term Disability (LTD) generally covers disabilities that last more than a year. To apply for LTD, speak with your employer's human resources department, or contact a private insurance company.

Low Income Subsidy (LIS) (Extra Help)

The full subsidy is for people who also get Medi-Cal coverage or who are in a Medicare Savings Program (MSP). You may also qualify if your countable income is less than $16,389 per year and your resources are less than $7,560, if you are single (the limits are higher for larger households).

The partial subsidy is for people who can’t get the full subsidy, but have less than $18,210 in countable income and less than $12,600 in resources, if you are single (the limits are higher for larger households).

With the partial subsidy, you will pay 0%, 25%, 50%, or 75% of the Part D premium, depending on your income, and will only have to pay a $83 deductible before you get help paying for drugs. You will have to pay coinsurance and copayments for your medications, but they will be lower than they would be without the partial LIS.

Note: Not all of your income and resources are counted when you apply for the Low Income Subsidy. You can apply for the LIS even if you are not sure that you will qualify.

Medicaid

A joint Federal and state program that provides assistance with medical costs to some low income individuals with limited resources. Medicaid programs vary from state to state. The federal Medicaid program is called Medi-Cal in California.

Medi-Cal Managed Care

A Medi-Cal program that requires most recipients to receive services within a network. Recipients are assigned a primary care provider who is responsible for managing their care. Also known as Medi-Cal Prepaid Health Plan.

Medi-Cal Prepaid Health Plan

Medical Provider (SDI)

The person who provides a medical certification of a disability. They can be a licensed physician, surgeon, U.S. government medical office, osteopathic physician, chiropractor, podiatrist, optometrist, dentist, designated psychologist, nurse-midwife, nurse practitioner, midwife, or accredited religious practitioner.

Medical Savings Account (Medicare)

A Medicare Advantage (Part C) option where Medicare gives your plan money to deposit into a savings account. You can use this money to pay for Medicare costs. After you meet a high yearly deductible, the plan will help pay for Medicare services.

Medical Underwriting

The review of an individual’s medical history and/or medical records to determine if the individual is eligible for coverage. Medical underwriting, which may include new medical testing, can be used to deny coverage or determine if a particular pre-existing condition will be covered.

Medicare

A federal program that provides health insurance for people 65 or older and many people under 65 who have disabilities. After a person gets Social Security Disability Insurance (SSDI) benefits for two years, he or she qualifies to get Medicare as well.

Medicare Health Maintenance Organization (HMO)

A Medicare Advantage option that can have lower copayments than the Original Medicare Plan, but generally limits individuals to visiting doctors, specialists, or hospitals within the plan's network. Plans must cover all Medicare Part A and Part B services, and some plans cover extras, like prescription drugs. Medicare Managed Care Plans are only available in some areas of the country.

Medicare Part D

Medicare Preferred Provider Organization (PPO) Plan

A Medicare Advantage option that gives an individual the choice of visiting providers within the network or seeing a provider outside of the network for an additional cost. An individual does not need a referral from their primary care physician to see a specialist.

Medicare Private Fee-for-Service Plan

A Medicare Advantage option that allows an individual to go to any Medicare-approved doctor or hospital. The insurance plan, rather than the Medicare program, decides what services it will cover and how much it will pay. Although an individual may pay more under this plan, he/she may have extra benefits that the Original Medicare Plan doesn't offer.

Medicare Supplement

A supplemental insurance policy sold by private insurance companies to fill gaps in the Original Medicare Plan. In California, there are 12 Medicare supplement plans labeled Plan A through Plan L.

Medicare supplement plans are available only to individuals using the Original Medicare Plan, and it is illegal for an insurance carrier to sell a Medicare supplement to an individual who does not have Original Medicare.

Minimum Basic Standards of Adequate Care (MBSAC)

A tool used by California’s Department of Social Services to determine CalWORKs eligibility.

The MBSAC is a limit that is compared to your countable income. If your family’s countable income is lower than the MBSAC for a family in your situation, your family will be eligible for a CalWORKs cash benefit. The MBSAC limit depends on how many people are in your family and whether you live in Region 1 or Region 2.

Region I includes the more urban counties (Alameda, Contra Costa, Los Angeles, Marin, Monterey, Napa, Orange, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Sonoma, and Ventura) where cost of living is higher, so the MBSAC is correspondingly higher. Region II includes the more rural counties (all of the ones not listed above).

Note: THE MBSAC limit is not your benefit amount. Is is simply a tool to determine whether your family is eligible for CalWORKs.

Mortgage

Needs Assessment

An evaluation that measures an individual's ability to complete activities of daily living (dressing, toileting, bathing, eating, respiration, getting around in the house) and instrumental activities of daily living (housekeeping, shopping, taking medication, meal preparation, managing finances, and getting around out of the house). The needs assessment determines an individual’s level of need for the In-Home Supportive Services Program.

Notice of Action (NOA)

OBRA

If you are on COBRA for 18 months, you may be able to extend your health care coverage for an additional 11 months via OBRA protections. Important: You must apply for OBRA within 30 to 60 days of the date that you're approved for Social Security Disability Insurance (SSDI).

Onset Date (Social Security)

The date, after reviewing an individual's medical records, that Social Security determines that a disability began. The date Social Security receives an application does not necessarily establish the onset date.

On-the-Job Training (OJT)

An employment activity under the Welfare-to-Work Program that provides skills to CalWORKs participants. An employer in the public or private sector can receive compensation for On-the-Job Training of a CalWORKs recipient.

Open Enrollment Period

The annual time period when an individual may add or change private insurance plans offered by an employer, an association, or through Covered California. Certain situations, such as divorce, the birth of a child, or loss of another insurance plan may allow a person to sign up for an insurance plan outside of this time period.

Opportunistic Infection

Original Medicare

A pay-per-visit health coverage plan that allows individuals to go to any doctor, hospital, or other health care supplier who accepts Medicare and who is accepting new Medicare patients. The individual is responsible for paying a deductible and copayment. Under Original Medicare, Medicare pays a portion of the Medicare-approved amount, while the individual pays for his/her share (coinsurance).

Individuals with Medicare choose to either stay in Original Medicare or enroll in a Medicare Advantage Plan. Medicare Advantage plans will have different costs and covered services than Original Medicare.

Out-Of-Pocket Costs

Out-Of-Pocket Maximum

The maximum amount of money that you have to spend on health costs in a year. After you reach the out-of-pocket maximum, your policy will pay the entire cost of covered services. The out-of-pocket maximum does not count the premiums you pay, and certain other costs may or may not be counted.

Overpayment

Paramedical Services

Services that are prescribed by a doctor and often administered by in-home care providers. They typically require some level of training or judgment and are essential to the health of the recipient. Common examples include injections, administration of medication, catheter insertion and care, tube feeding, ventilator and oxygen care, treatment of wounds, and other services requiring sterile procedures.

Parental Control

Social Security uses this as one measure of whether or not a beneficiary should receive an independent living benefit rate. A child is considered to be under "parental control" if their parent has the authority to make decisions on their behalf.

Parent-to-Child Deeming

Social Security’s process of figuring out how much of parents’ income is used to pay for a child’s basic needs. Some of the parents' income may be considered the child's when determining whether or not the child is eligible for disability benefit programs.The amount of deemed income is subtracted from the benefit amount.

Personal Assistance Services (PAS)

Personal Care Assistant (PCA) Services

Assistance and support services for people with disabilities who live independently in the community. A qualified personal care assistant provides the services in the person’s own home or in the community.

Plan to Achieve Self-Support (PASS)

A Supplemental Security Income (SSI) program that allows you to set aside income and assets for expenses related to a specific work goal. Income that you use for these expenses will not cause your SSI benefits to go down. Assets that you spend on PASS expenses won't count towards the SSI limit.

Point-Of-Service (POS) Plan (Private Health Coverage)

A type of health coverage that allows you to choose between HMO, PPO, and Indemnity coverage. You can choose to pay less and have your care managed by a physician, or pay more to have more choices in the doctors you can see.

Potentially Disabling Condition

Power of Attorney

A legal written document that lets someone else (called an agent) act for you in legal, financial, business, or personal matters. The agent can make decisions, sign legal documents, buy or sell items, or handle banking and other accounts for you.

Pre-Disability Income

Pre-Disabled

A person who is HIV-positive, but does not have an AIDS diagnosis, Opportunistic Infections (OI), or any other symptoms. Somebody who is pre-disabled is likely to become disabled without medical treatment.

Pre-Existing Condition

Any condition for which “medical care” was received within six months prior to the effective date of insurance coverage. Medical care includes the use of prescription drugs and physician consultations and services. During a pre-existing condition exclusionary period, coverage for that condition is either not provided or can be limited.

Pre-Existing Condition Exclusionary Period

The period of time from the coverage effective date that the insurer does not cover a pre-existing medical condition. The individual will normally be covered for the condition once the specified time has elapsed.

Pre-Existing Condition Insurance Plan (PCIP)

Government-run insurance plans for people who couldn’t get insurance because of pre-existing medical conditions, PCIPs ended on January 1, 2014. Now, insurance companies cannot deny people health coverage because of pre-existing conditions. People who don’t have health insurance can get coverage through Covered California.

Preferred Provider Organization (PPO)

A type of health insurance plan. You pay a monthly premium and — when you use medical services — copayments and deductibles. PPOs have networks of physicians. You can see any doctor in the network without getting prior authorization from a primary care physician. Seeing a doctor outside of the network is more expensive.

Premium (General)

Premium (Medicare)

If you're on SSDI or CDB and Medicare, you likely won't have to pay a premium for Medicare Part A coverage. You may have to pay a Part B premium, however. For most people, the premium for Part B coverage is $134 per month or a bit less, depending on their situation. If you qualify, a Medicare Savings Program or other programs can help pay for your Part B premium.

If you sign up for Part D prescription drug coverage or have a Medicare Advantage (Part C) plan instead of Original Medicare, you will also usually have to pay a premium. The exact amount of your premium will depend on the plan you choose.

Presumptive Disability

A status granted to Supplemental Security Income (SSI) applicants who have a high chance of being found disabled according to Social Security Administration (SSA) standards. If the SSA finds you presumptively disabled, they will begin benefit payments while your application is still being reviewed.

The SSA may find you presumptively disabled if you meet the medical criteria of the Blue Book Listing of Impairments or if you have HIV/AIDS and meet the criteria of SSA Form 4814. In either case, you must also meet SSI financial requirements to be eligible for presumptive disability benefits.

Repayments of presumptive disability benefits are not required even if SSI benefits are ultimately denied.

Primary Care Physician (Medicare)

A doctor who provides basic care and acts as an individual’s first point of contact when seeking health services. In many Medicare Managed Care Plans (Medicare HMOs), an individual may need to see their primary care doctor before going to a specialist.

Primary Care Provider (PCP)

The doctor, nurse practitioner, or other medical service provider who is in charge of your medical care in a Health Maintenance Organization (HMO). In HMOs, you have to see a PCP in order to get a referral to see a specialist. Other types of health coverage might not have PCPs, or might charge you more if you see a specialist without getting a referral from a PCP.

Prior Authorization (Medicare)

Prior Authorization (Private Health Coverage)

A health plan process of reviewing medical services or medications before they give you permission to go ahead with the service or use the medication. This is done to ensure that the service or medication is appropriate and necessary before the plan pays for it.

Private Duty Nursing

The care of clients by nurses. Most nurses who provide private duty care are working one-on-one with individual clients. Sometimes such care is provided in the client's home, or an institution, such as a hospital, nursing home, or other such facility.

Private Health Coverage

Health coverage through a private company that pays for medical expenses. A monthly premium must be paid for this coverage by the individual or family covered, by an employer, or by an association. The individuals covered by private health plans must also make payments such as copayments or coinsurance each time they use certain medical services.

In some cases, the federal government may help low to middle-income families pay for private health coverage through tax subsidies if they are in very specific situations and do not have other affordable health coverage alternatives.

Private Mortgage Insurance (PMI)

Probate

A legal process after a person dies during which a court decides whether that person’s will is valid or not. If the person didn’t leave a will, the court will decide who gets the person’s money and property. The process can be complicated, and take anywhere from a few months to several years.

Project-Based Housing

Specific units in privately owned buildings set aside for people who qualify for housing programs that help pay rent.

If you get an apartment from a project-based housing program, you do not get to choose which apartment you will live in. With many project-based programs, you will pay about 30% of your income as rent, and the program will pay the rest.

The Section 8 project-based voucher (PBV) program is a large project-based housing program. Other project-based housing is available through HUD Homeless Programs, Section 202, and Section 811.

Property Essential to Self-Support (PESS)

Anything that you own and need to support yourself. If the Social Security Administration (SSA) approves the property that you claim is Property Essential to Self-Support (PESS), Social Security will not count these things as resources when figuring out if you are eligible for Supplemental Security Income (SSI) benefits. Three types of property can be excluded as PESS:

Property that you use in a trade or business (for example, your inventory) or personal property you use for work as an employee (for example, tools or equipment)

Up to $6,000 of the value of nonbusiness property that you use to produce something that helps with your daily living (for example, land that you use to produce vegetables that you eat)

Up to $6,000 of the value of property if the property gives you a return of at least a 6% per year (for example, property you own and rent to someone else)

You must be using the property to support yourself or expect to start using it again within a reasonable period of time, usually 12 months.

Protective Supervision

Public Housing

Rental housing for people with low income that is owned and managed by public housing authorities (PHAs). Public housing comes in many sizes and types, from single-family houses to large apartment buildings. Some public housing units are reserved for the elderly and people with disabilities.

Public Housing Authority (PHA)

A local agency that is in charge of assigning Section 8 housing vouchers, taking care of upkeep of public housing, and making sure that the housing is safe, decent, and affordable. The U.S. Department of Housing and Urban Development (HUD) oversees and assists PHAs.

Qualified Alien

According to Social Security, you are considered a qualified alien if the Department of Homeland Security (DHS) says you are in one of these categories:

Lawfully Admitted for Permanent Residence (LAPR) in the United States, including "Amerasian immigrant" as defined in Section 584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1988, as amended;

granted conditional entry under Section 203(a)(7) of the Immigration and Nationality Act (INA) as in effect before April 1, 1980;

paroled into the United States under Section 212(d)(5) of the INA for a period of at least one year;

refugee admitted to the United States under Section 207 of the INA;

granted asylum under Section 208 of the INA;

deportation is being withheld under Section 243(h) of the INA as in effect before April 1, 1997, or removal is withheld under Section 241(b)(3) of the INA; or

“Cuban or Haitian entrant” under Section 501(e) of the Refugee Education Assistance Act of 1980 or in a status that is to be treated as a “Cuban or Haitian entrant” for SSI purposes.

Qualified Jobseeker

A person who (a) has certain characteristics that the employer asks job applicants to have, such as education, work experience, skills, or licenses, and (b) can perform the essential functions of the job with or without reasonable accommodations.

Qualified Medical Expense

Expenses for certain items or services that are approved by your Flexible Spending Account (FSA) (also called a Flexible Spending Arrangement). You should get a list of what things count as qualified medical expenses, so you know ahead of time which things will be covered by your FSA, and which things will not

Qualifying Child

An IRS classification that may allow a taxpayer to claim the EITC and certain other tax credits. In general, to be a taxpayer’s qualifying child, a person must satisfy four tests:

Relationship — the taxpayer’s child or stepchild (whether by blood or adoption), foster child, sibling or stepsibling, or a descendant of one of these.

Residence — has the same principal residence as the taxpayer for more than half of the tax year. Exceptions apply, in certain cases, for children of divorced or separated parents, kidnapped children, temporary absences, and for children who were born or died during the year.

Age — must be under the age of 19 at the end of the tax year, or under the age of 24 if a full-time student for at least five months of the year, or be permanently and totally disabled at any time during the year.

Support — did not provide more than one-half of his/her own support for the year.

Qualifying Family Member

A spouse, domestic partner, or parent whose employer-sponsored health plan premiums are paid for by Medi-Cal/HIPP. Medi-Cal/HIPP pays premiums for qualifying family members when it is cost effective to enroll the family member in the employer-sponsored plan.

Quick Benefit Restart

A feature of the SSI program that makes it easy to restart your SSI benefit if you lost it because of work alone. If you are 1619(b) eligible and you stop working, you will be able to get your SSI benefit restarted quickly without having to file a new application or wait for medical review.

Reasonable Accommodation Request

A request to an employer to make a modification to a job or workplace that allows an employee to successfully perform the essential duties of a job. The request can come from the employee, or an employee's friend, family member, or medical provider. Reasonable accommodation rules are case-by-case situations, and employers and employees can negotiate the terms under the law.

Regular Attendance (SEIE)

Attend a college or university for at least eight hours a week under a semester or quarter system

Be in grades 7 - 12 for at least 12 hours a week

Be in a course of training (with shop practice) for at least 15 hours a week to prepare for a paying job

Be in a course of training (without shop practice) for 12 hours a week

In some circumstances, like illness or unavailability of transportation, students may be allowed to spend less time than indicated above and still be considered “regularly attending” for the purposes of the SEIE.

Representative Payee

A person who gets and manages benefits on someone else's behalf. Social Security does an investigation before making a relative, friend, or other person the representative payee of a beneficiary who needs help managing their benefits. For children under 18, a parent or guardian is usually the representative payee.

Resource Exclusions (CA programs)

Household goods and personal effects that have a total value of $2,000 or less

One car if it is: necessary for employment, or necessary for medical treatment, or modified for use by a disabled person, or it provides necessary transportation to perform essential daily activities, or has a current market value less than $4500

Property of a trade or business that is essential for self-support

Non-business property which is essential to self-support

Resources of a blind or disabled individual necessary to fulfill an approved PASS

Certain stocks held by Alaskan natives

Life insurance, if the total face value of all policies on one person do not exceed $1500. Otherwise, the cash surrender values of life insurance policies will count as a resource

Resource Exclusions (SSI)

In addition to the home you live in and one car, there are several other resources that may be excluded when determining your Supplemental Security Income (SSI) countable resource total. Earned Income Tax Credits (EITC), Child Tax Credits (CTC), CalFresh (formerly Food Stamps), grants, scholarships, fellowships, gifts, property essential to self-support, Individual Development Accounts (IDAs), and many other items may be excluded. Additionally, for SSI, the first $100,000 in an ABLE account are not countable resources.

Resource Limit

The maximum amount of resources you're allowed to own while maintaining eligibility for a particular disability benefits program. Most benefits programs do not count everything you own, including the home you live in and one car you own. For Supplemental Security Income (SSI), the first $100,000 in an ABLE account is not counted as resources. For Medi-Cal, CalFresh (formerly Food Stamps), and some other programs, none of the money in an ABLE account is counted.

Also called an "asset limit."

Resources

Cash or property that you own, can convert to cash, or can use to support yourself. Stocks, bonds, and savings accounts are a few examples of resources. The home you live in and the car you drive to work are exempt under most Social Security and state disability benefit programs. For Supplemental Security Income (SSI), the first $100,000 in an ABLE account is not counted as resources. For Medi-Cal, CalFresh, and some other programs, none of the money in an ABLE account is counted.

Also called "assets."

Retirement, Survivors, and Disability Insurance (RSDI)

Social Security program that provides monthly income to people with disabilities, survivors or dependents of people with disabilities, and retired people. Social Security Disability Insurance (SSDI) is one part of RSDI.

Retroactive Payments

Revenue

The total amount of money that a business earns before expenses are deducted.

Example: Julia's consulting business earns $5,000 per month, but spends $2,000 per month on expenses. Her company's total monthly revenue is $5,000; her company's monthly net income ($5,000 minus $2,000) is $3,000.

Secondary Payer

A health insurance plan that supplements a primary insurance plan. Health care costs not covered by the primary plan can be submitted to the secondary payer, which often covers some or all of the deductibles, copayments, and other services not covered by the primary insurance provider.

Section 301

A rule that allows certain people to keep their Social Security benefits after being found to no longer be medically disabled. For Section 301 to apply, a person who gets benefits has to be participating in a Social Security approved employment support program, and participation in that program has to increase the likelihood that he or she will not need Social Security benefits after completing the program. Vocational rehabilitation and PASS are two examples of “Social Security approved employment support programs."

Self-Employment

Self-Initiated Program

Full-time vocational training or education that also fulfills the work activity requirements under the Welfare-to-Work Program. The training or program must be expected to be completed within 24 months and take place at an approved school.

Self-Insured Plan

A plan that covers an individual’s medical expenses with company funds set aside to pay health claims. In general, self-insured plans are subject to federal, but not state, health coverage laws. Ask your employer or plan to find out if you are in a self-insured plan.

Service Wait

The period of time an individual is required to be employed by a company or be a member of an association before becoming eligible to enroll for the group’s health coverage. Also known as the minimum service requirement.

Short Sale

Short-Term Disability Insurance

Private insurance that replaces some of your income when you can't work because of a disability. Short-Term Disability (STD) generally covers disabilities that last a year or less. To apply for STD, speak with your employer's human resources department, or contact a private insurance company.

Skilled Nursing Facility Care

Services that include a semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies. Medicare covers skilled nursing facility care after the individual has been in the hospital for three days.

SSDI also offers benefits to family members, including children and widows, when a primary wage earner in the family becomes disabled or dies. Additionally, adults whose disabilities began before they turned 22 may be able to get Childhood Disability Benefits (CDB).

Special Enrollment Period (Medicare)

The period when an individual can apply for Medicare coverage without a late enrollment penalty and can sign up for Medicare supplement without a pre-existing condition waiting period. The special enrollment period typically spans the first eight months following the loss of group health coverage.

Special Enrollment Period (Private Health Coverage)

When you get private group health coverage through your employer, you can only sign up for, or make changes to, an insurance plan during the open enrollment period. However, under certain circumstances, such as marriage, birth of a child, or loss of other insurance, a group health plan offers a special enrollment period. This special enrollment period lets you sign up for group health insurance, or make changes to your plan, without having to wait for an open enrollment period.

Special Need Payment

Special Needs Plan (SNP)

A Medicare Advantage option that provides health care focused on certain health conditions. These plans provide comprehensive Medicare coverage to manage a particular disease or condition, such as congestive heart failure, diabetes, or End-Stage Renal Disease (ESRD). Medicare Special Needs Plans are only available in some areas of the country.

Special Needs Trust

A legal arrangement that lets someone else (a person or an organization, called the trustee) manage resources or assets for a person with disabilities (called the beneficiary). If a Special Needs Trust is set up correctly, the money in the trust won’t count toward the resource or asset limits for benefits programs like Supplemental Security Income (SSI) or Medi-Cal, and it can be used to pay for the beneficiary’s expenses that aren’t covered by their public benefits. If you are the beneficiary of a Special Needs Trust, your trust can have more assets in it than the resource limits for benefits programs usually allow, and the money can pay for things like recreation, telephone bills, education, and vacations.

Student Earned Income Exclusion (SEIE)

An exclusion that allows most students to work without their SSI benefit decreasing. The SEIE lets you keep the first $1,820 in earnings each month without affecting the countable earned income calculation. But there is an annual cap of $7,350, so if you earn more than this in any given year, the income starts counting again.

Subsidized Employment (Public & Private)

Subsidy (Individual Health Coverage)

A support provided by the federal government that helps people and families with low to middle income pay for their health coverage when they purchase it through Covered California. This support means that individuals and families may qualify to get health plans with lower premiums and other expenses.

Families with income at or below 400% of the Federal Poverty Guidelines (FPG), $48,560 for an individual in 2018 ($100,400 for a family of four), may get help paying for their health coverage premium.

Families with income at or below 250% of FPG, $30,350 for an individual ($62,750 for a family of four), may also get qualify to get health coverage with lower expenses, such as reduced copayments, coinsurance, or deductibles, as long as they choose to get a silver plan.

Substantial Gainful Activity (SGA)

The amount of monthly earned income that shows a person is doing significant work according to Social Security. People who cannot earn more than SGA due to their disabilities may be considered disabled by Social Security and other agencies that use Social Security’s definition of disability.

Supplemental Security Income (SSI)

A Social Security Administration program that gives cash benefits to people with disabilities who have limited income and resources. The amount you get in SSI benefits is based on your financial need and your living situation. The maximum monthly SSI benefit is $910.72 for individuals and $1,532.14 for eligible couples.

Surrender Value

If you were to cancel a life insurance policy prior to death or maturity, you would likely receive some portion of the full value of that policy. The amount you would receive is known as the “surrender value.” The surrender value of your policy should be written into it. If you do not know the surrender value, contact your policy administrator to find out. Not all policies have a surrender value (i.e. - burial insurance and many term insurance policies).

Tax deduction

The amount that a person or business can subtract from their taxable income. The more you can deduct, the less you pay. Items which reduce your taxes are referred to as deductable expenses. If you earn $10,000 dollars in a year, and have $2,000 dollars in tax deductions, you only pay taxes on $8,000 ($10,000-$2,000= $8,000).

Tax Penalty (Individual Mandate)

A fee that people without health coverage may need to pay. The fee in 2018 is $695 or 2.5% of your income, whichever is greater.

Uninsured people won’t have to pay the fee if they:

Are uninsured for less than 3 months of the year

Have very low income

Do not file a tax return because their income is too low

Earn 138% of the Federal Poverty Guidelines (FPG) or less ($16,753 or less for an individual; $34,638 for a family of four) and live in a state that hasn’t expanded Medi-Cal eligibility

Are a member of a federally recognized Indian tribe

Have religious objections to health insurance

The tax penalty (individual mandate) continues to be law for 2017 and 2018

The Tax Cuts and Jobs Act, signed at the end of 2017, is set to end the tax penalty (individual mandate) for health coverage starting in 2019. It does not affect this rule for health coverage in 2017 and 2018.

The bottom line:

For 2017, if you didn't have coverage, you may still have to pay a penalty on your 2017 taxes (due in April of 2018).

For 2018, if you don't have coverage, you may still have to pay a penalty on your 2018 taxes (due in April of 2019).

Temporary Assistance for Needy Families (TANF)

A federal welfare program, formerly known as Aid to Families with Dependent Children (AFDC), that provides income support and access to Medi-Cal for low-income adults with children. In California, TANF is known as CalWORKs.

Timely Progress

Active participation in the Individual Work Plan (IWP) during the first two years of the Ticket program. Thereafter, timely progress is referred to as "increased work activity and earnings" (Year 3, 4, and 5).

As long as an individual is making timely progress on the IWP, Social Security will not initiate a medical Continuing Disability Review (CDR).

Trial Work Period (TWP)

The Trial Work Period is the nine Trial Work months occurring within a five-year window when you can work and continue to get your full SSDI benefit. These work months can occur one right after the other or be spread out over time.

Underinsured Individual

Undue Hardship

A reasonable accommodation you request that is too difficult or too expensive for an employer to get, in relation to the employer's size, financial resources, and the needs of the business. If a reasonable accommodation request causes an employer "undue hardship," then the employer does not have to get the requested accommodation.

Unearned Income (UI)

Funds received from sources for which no paid work activity is performed. Disability benefits such as SSDI, SSI, short-term disability insurance, and long-term disability insurance; VA benefits; Workers' Compensation; income from a trust or investment; spousal support; dividends, profits, or funds received from any source other than work are all usually considered unearned income.

Unemployed (CalWORKs)

CalWORKs generally defines unemployed as having worked less than 100 hours in the previous 4 weeks. In a two parent household, one of the parents can work more than 100 hours per month so long as the family income after deductions (countable income) is below the income limit for the program.

Uniformed Services Employment and Reemployment Rights Act (USERRA)

The Uniformed Services Employment and Reemployment Rights Act (USERRA) is a federal law that protects veterans’ and service members’ employment rights. It says that a person can miss up to five years of work because of military duty and have the right to be re-employed by the employer they had before going on duty. It also requires employers to make reasonable accommodations for disabled veterans.

Unincurred Business Expenses

Financial or other assistance from an agency or individual to help establish or sustain a self-employed person’s business. Examples include a government agency paying for some of your business expenses, or providing you with things of value (e.g. office space) free of charge.

Social Security rules do not penalize you for receiving unincurred business expenses. Instead, Social Security deducts the value of any unincurred business expenses from your net income when deciding if you have reached the Substantial Gainful Activity (SGA) level for any given month. SSA uses fair market value to assess the value of any unincurred business expenses.

Uninhabitable Residence

Unpaid Help

The estimated value of any unpaid assistance from your spouse, children or others provided to your business. If someone provides your business with 10 hours/month of free web design work, and the prevailing wage for that kind of work in your community is $25/hour, the value of that unpaid help is $250/month.

Social Security rules do not penalize you for receiving unpaid help. Instead, Social Security deducts the value of any unpaid help that your business receives from your net income when deciding if you have reached the Substantial Gainful Activity (SGA) level each month.

Vesting Requirement

Victim of Trafficking

An individual who is a victim of sex trafficking; or, a victim of the forced or fraudulent recruitment, harboring, transport, or provision of a person for labor or services that subject the person to involuntary servitude, peonage, debt bondage, or slavery.

Vocational Assessment

A service to help a person examine their work skills, education level, employment background, and interests, in order to help them decide on a career path that will be well matched to their skills and interests.

Vocational Counselor

Vocational Rehabilitation

A state agency that helps people with disabilities prepare for, find, and keep jobs that are consistent with their skills, strengths, and interests. Arizona's Vocational Rehabilitation agency is called the Arizona Rehabilitation Services.

W

Wage Replacement

A type of benefit that provides money each month to make up for wages you no longer receive due to disability. It can be either a percentage of your pre-disability income or a fixed dollar amount. Short-Term or Long-Term Disability Insurance are private wage replacement programs, while Social Security Disability Insurance (SSDI) is a public program. Wage replacement is also known as pay replacement or income replacement.

Wage Subsidy and Special Conditions

For the purposes of calculating Substantial Gainful Activity (SGA), wage subsidy and special conditions are support you get on the job that may result in your getting more pay than the actual value of the services you perform. Wage subsidy refers to support you get from your employer; special conditions are generally given to you by someone other than your employer, for example a vocational rehabilitation agency.

Social Security looks at wage subsidy and special conditions when they make an SGA decision. They only use earnings that represent the real value of the work you perform to decide if your work is at the SGA level. If Social Security decides that wage subsidy or special conditions exist, you can earn more while continuing to get your benefits.

Wage subsidy or special conditions may exist if:

You get more supervision than other workers doing the same or a similar job for the same pay

You have fewer or simpler tasks to complete than other workers doing the same job for the same pay, or

You have a job coach or mentor who helps you perform some of your work

Note that Social Security uses wage subsidy and special conditions rules when they are deciding if you have earned Substantial Gainful Activity after your SSDI Trial Work Period is over. Social Security does not use these rules during your Trial Work Period or in any Trial Work month.

Waiting Period (Short- and Long-Term Disability)

The amount of time you have to wait between becoming disabled and receiving a benefit. For example, many private disability plans begin paying benefits 7 days after an illness forces you to leave work.

Welfare-to-Work Activities

Activities that meet the Welfare-to-Work requirement. Most CalWORKs recipients must participate in 20 hours of core activities. Your county may include all or some of the following as acceptable core activities:

Subsidized or unsubsidized employment

Work experience

On-the-job training

Work-study

Self-employment

Community service

Vocational education and training

Job search and job readiness assistance

The rest of the Welfare-to-Work requirement can be fulfilled with non-core activities, which may include:

Work

Work Credits (SSDI)

One of the eligibility requirements for SSDI is to have worked and paid FICA taxes for specified periods of time. If you work and earn at least $1,320 for one quarter (three months), and pay FICA taxes, you earn one SSDI "work credit." You can earn up to four credits within a 12-month period.

The number of work credits needed to qualify for SSDI depends upon how old you were when Social Security determined that you are disabled.

If you were determined disabled before age 24, you need six credits within the past three years to be eligible for SSDI.

If you were determined disabled between the ages of 24 and 31, you need 12 credits within the past six years to be eligible for SSDI.

If you were determined disabled after you turned 31, you need the number of work credits shown in the table below. And unless you are blind, you need to have earned at least 20 of those credits in the 10 years prior to becoming disabled.

Work Opportunity Tax Credit (WOTC)

A federal program that encourages employers to hire job seekers from one of nine targeted groups by offering employers a federal tax credit. The purpose of the WOTC is to help job seekers in the targeted groups overcome barriers to employment.

Workplace Personal Assistance

Work-Study

A program that you may qualify for if you apply for financial aid at your college or university. If you qualify, it will be easier for you to get a part-time job on campus or nearby, because the federal government will help some employers pay your salary.